| NPI | 1205087459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0064) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR 24867) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 94-10-114) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 011092) | |
| 101YP2500X Counselor, Professional (Licence: OR C0770) | |
| 106H00000X Marriage & Family Therapist (Licence: UT 105700-3902) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2024-09-14 |